Overview
The Policy Analyst will be responsible for drafting, editing, reviewing, auditing, tracking, monitoring, and maintaining policies and procedures for Partnership HealthPlan of California. Alongside designated organizational leadership, ensures compliance with governing rules, regulations, and/or accreditation standards. Reviews both draft and final All Plan Letters (APLs) and/or regulatory changes and supports leaders with the research, planning, implementation and/or operational readiness submissions across the organization.
Responsibilities
- Performs policy research to analyze current and/or new regulations by applicable Partnership regulators and/or accrediting agencies (ex: DHCS, DMHC, CMS, NCQA, etc.)
- Reviews timely draft and/or final All Plan Letters (APL), Policy Guides and/or other DHCS guidance for policy impact.
- Proactively identifies policies impacted by regulatory changes.
- In collaboration with stakeholders throughout the organization, drafts and prepares new policies.
- Performs document management by organizing, tracking and maintaining all policy updates and renewal cycles in PowerDMS.
- Prepares all policies and/or related materials for appropriate committees’ review and/or submission to associated regulatory or accrediting agencies.
- Supports Partnership audit and compliance readiness by submitting all materials timely.
- Serves as PowerDMS ‘Super User’ in the organization to effectively route policies with multi-departmental impacts to appropriate reviewers.
- Participates in audits with Partnership’s regulatory and/or accreditation bodies by preparing policies, documents and/or reports as needed.
- Communicates and coordinates across the organization to ensure that all active and current Partnership policies are available and reflected on Partnership websites.
- Makes strategic recommendation(s) to improve the accuracy, compliance, quality, performance and/or increase efficiencies within the organization.
- Assists in conducting risk assessments to identify potential areas of compliance vulnerability and areas at high risk of non-compliance; making recommendation for risk mitigation interventions.
- Conducts analysis, collects information, and evaluates impact of regulatory and compliance issues to inform auditing and monitoring activities.
- Analyzes the impact of new programs/benefits and efficacy of existing processes, policies, procedures and trainings.
- Consults with department leadership on a wide variety of compliance related subject matter areas as it relates to policies and procedures.
- Participates in special projects and assignments, as assigned.
- Attends all major committee meetings as policy and procedure advisor and key consultant on policy and procedure matters.
- Other duties as assigned.
Qualifications
Education and Experience
Bachelor’s degree in Liberal Arts, Communication, Business Administration, Health Care Administration, Political Science, or related field; 3-4 years of experience in the health care field, managed care experience preferred, with knowledge of the Knox-Keene, Medicare, Medi-Cal, and Healthy Families regulations; or equivalent combination of education and experience. Experience with health plan audits preferred.
Special Skills, Licenses and Certifications
Working knowledge of Medi-Cal, Department of Health Care Services (DHCS) and/or National Committee on Quality Assurance (NCQA) regulations and standards. Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Project, typing speed of 40 wpm. Valid California Driver's License and proof of current automobile insurance compliant with Partnership’s policies are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain effective filing systems, and meet deadlines. Ability to work under minimal supervision and exercise independent judgment. Diplomacy and tact in handling sensitive information regarding personnel affairs as required. Ability to interact with executives and vendors effectively, handling all assignments with efficiency. Must be able to handle multiple tasks and meet deadlines. Excellent judgment. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and deadlines. Strong organizational skills required.
Work Environment And Physical Demands
Ability to use a computer keyboard. Ability to prioritize workload and initiate action to acquire needed information from professionals by phone. Ability to function effectively with frequent interruptions and direction from multiple team members. More than 50% of work time is spent in front of a computer monitor. Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. Some travel required (up to 25%) including occasional overnight.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
HIRING RANGE:
$93,690.86 - $117,113.58
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
#J-18808-Ljbffr
